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7
The Open Public Health Journal
Content list available at: https://openpublichealthjournal.com
EDITORIAL
The 2020 Novel Corona Virus Outbreak: One Year On
Matthias Beck1,*, Damian Tobin1 and Gail Sheppard2
1
Department of Management & Marketing, University College Cork, National University of Ireland, Cork, Ireland
2
Department of Accounting, Finance & Professional Studies, Technological University Dublin, Tallaght, Ireland
1. INTRODUCTION much higher, amounting to over 70% for population-rich
Japan, France, Germany, Italy, Turkey and the UK, which
On December 31, 2019 Chinese health authorities reported
highlights the importance of non-pharmaceutical interventions
an outbreak of atypical pneumonia in Wuhan, the capital of
in suppressing the escalation of Covid peaks.
Hubei province [1]. On January 7, 2020 Chinese authorities
attributed this to a new type of coronavirus (novel corona- Countries that did experience these peak concentrations
virus, Covid or nCoV) [2]. The WHO declared the outbreak a differ widely in terms of the relative size of the first peak
Public Health Emergency of International Concern on January (April & May) as compared to the second peak (November &
30, 2020 [3, 4]. December). This is partly due to more or less effective
measures to contain these. Nonetheless, there is a strong
About one year later, on January 5, 2021 the WHO
correlation between the number of first and second peak
reported a cumulative Covid case number of over 83 million
fatalities, which Fig. (1) depicts in double log format. This
and over 1.8 million deaths globally since the start of the correlation allows for an approximate identification of
pandemic [5]. For the week prior to January 5, 2021 alone, a countries that worse or better in terms of Covid fatalities than
total of 76,000 deaths were registered by the WHO, with the the model would predict when the first peak was followed by
region of the Americas accounting for 47% of all new cases the second; with those above the line having fared worse, and
and 42% of all new deaths globally, and the European region those below the line better. A more detailed interpretation of
for 38% and 43% respectively; bringing the combined count of this data in terms of health systems capability is difficult
these two regions to 85% for recent global cases and recent because of the aforementioned avoidance of a full blown first
global deaths [5]. wave in some countries (e.g. Austria, Czechia, Greece,
Hungary, Poland, Slovakia), or a very high relative number of
2. THE TWO PEAK PATTERN deaths to population rate during the first peak period (e.g.
For most countries in Europe, some countries in the Belgium), which would have made statistical improvements
Americas, and a small number of Asian countries, the recent during the second peak period likely. The success of some
deaths are part of a pronounced second peak, and it is sobering countries in suppressing the first peak or wave of Covid has
to examine the concentration of Covid deaths within the two been attributed to a number of factors including delayed
time periods from April to May, 2020 (first peak) and from landfall of Covid, early imposition of lockdown measures as
November to December, 2020 (second peak). Table 1 shows well as stringent enforcement measures [6 - 10].
this concentration of Covid fatalities for countries that were The analysis of Covid fatalities relative to population [6, 7]
affected by Covid early on (excluding China), with data being during the first and second peaks confirms the presence of
drawn from official WHO reports [6]. shifts in the relative position of countries over time. Table 2
With the exception of seven countries (India, Australia, shows Covid fatality rates per 100,000. For each column of
Ireland, Sweden, Mexico, Brazil and Chile - highlighted in Table 2, the eight countries (out of 24) with the highest fatality
green), all other early Covid affected countries listed here (24 rates (per 100,000) are highlighted in red, while the eight
in total) had more than 50% of deaths occur in these two countries with the lowest rates are highlighted in green.
periods of two months length. For most countries, this rate was The eight (of 24) countries with the highest Covid fatality
rates per 100,000 for the first peak include Belgium, France,
* Address correspondence to this author at the Department of Management &
Marketing, University College Cork, National University of Ireland, Cork, Italy, the Netherlands, Spain, the United Kingdom, Canada and
Ireland; E-mail: matthias.beck@ucc.ie the United States. For the second peak, they include Austria,
DOI: 10.2174/1874944502114010007, 2021, 14, 7-118 The Open Public Health Journal, 2021, Volume 14 Beck et al.
Belgium, Czechia, France, Hungary, Italy, Poland and category (marked red) for both peaks, which is potentially
Switzerland. This means that three (of eight) countries, namely indicative of a high vulnerability to the effects of Covid
Belgium, France and Italy, are ranked in the severely affected outbreaks.
14
y = 0.8001x + 2.2943
R² = 0.5774
12
us
it
fr uk
10 pl de
hs
cz tr
hu be
at ch ca
gr pt nl
8
sl jp
6 dk
kr
fl
no
4
2
0 nz
0 2 4 6 8 10 12 14
Fig. (1). Unweighted log-log scatterplot of first peak (April & May) and second peak (November & December) Covid fatality numbers (horizontal x
axis measures logged first peak deaths, vertical y axis measures logged second peak deaths).
Table 1. Concentration of Covid deaths during two peak month blocks (April & May, November & December) and expressed
as percentage of total.
Region Country - - Deaths - Peak Months Deaths as % of Total
- - - 1st peak 2nd peak Total 1st peak 2nd peak 1st & 2nd
- - - April-May Nov-Dec To Dec 30 April-May Nov-Dec Peak
Asia/Pacific India - 5126 28120 147622 3.47% 19.05% 22.52%
(W-.E) South Korea - 108 348 808 13.37% 43.07% 56.44%
- Japan - 835 1488 3213 25.99% 46.31% 72.30%
- Australia - 83 3 908 9.14% 0.33% 9.47%
- NZ - 21 1 25 84.00% 4.00% 88.00%
Europe Austria - 540 4764 5752 9.39% 82.82% 92.21%
- Belgium - 8748 8293 19192 45.58% 43.21% 88.79%
- Czechia - 288 8679 11044 2.61% 78.59% 81.19%
- Denmark - 481 445 1153 41.72% 38.59% 80.31%
- Finland - 299 170 524 57.06% 32.44% 89.50%
- France - 25700 27476 62197 41.32% 44.18% 85.50%
- Germany - 7917 19680 29778 26.59% 66.09% 92.68%
- Greece - 126 3972 4553 2.77% 87.24% 90.01%
- Hungary - 508 7512 9047 5.62% 83.03% 88.65%
- Ireland - 263 315 2200 11.95% 14.32% 26.27%
- Italy - 20910 34141 71620 29.20% 47.67% 76.87%
- Netherlands - 4912 3912 10974 44.76% 35.65% 80.41%
- Norway - 208 142 421 49.41% 33.73% 83.14%
- Poland - 1028 22635 27118 3.79% 83.47% 87.26%The 2020 Novel Corona Virus Outbreak The Open Public Health Journal, 2021, Volume 14 9
7DEOH1 FRQWG
Region Country - - Deaths - Peak Months Deaths as % of Total
- - - 1st peak 2nd peak Total 1st peak 2nd peak 1st & 2nd
- - - April-May Nov-Dec To Dec 30 April-May Nov-Dec Peak
- Portugal - 1236 4213 6556 18.85% 64.26% 83.11%
- Slovakia - 28 1608 1773 1.58% 90.69% 92.27%
- Spain - 20854 15072 49824 41.86% 30.25% 72.11%
- Sweden - 1028 2346 8279 12.42% 28.34% 40.75%
- Switzerland - 1283 4595 6508 19.71% 70.61% 90.32%
- Turkey - 4301 9750 19624 21.92% 49.68% 71.60%
- United Kingdom - 36587 25407 70405 51.97% 36.09% 88.05%
Americas Canada - 6907 4835 14781 46.73% 32.71% 79.44%
(N-S) United States - 98717 104315 328014 30.10% 31.80% 61.90%
- Mexico - 9387 32913 121837 7.70% 27.01% 34.72%
- Brazil - 27719 33354 190488 14.55% 17.51% 32.06%
- Chile - 985 31 16404 6.00% 0.19% 6.19%
Table 2. Covid fatality rates (per 100,000) during the two peak periods and for the total.
- - Covid Fatality Rates (per 100.000)
- - 1st peak 2nd peak Total
- - April-May Nov-Dec to Dec 30
Asia/Pacific South Korea 2.11 6.79 15.76
(W-.E) Japan 6.6 11.77 25.4
NZ 4.34 0.21 5.16
Europe Austria 60.67 535.22 646.22
Belgium 757.47 718.07 1661.79
Czechia 26.93 811.65 1032.83
Denmark 82.6 76.42 198.01
Finland 54.12 30.77 94.84
France 383.02 409.48 926.94
Germany 95.19 236.63 358.05
Greece 11.76 370.87 425.12
Hungary 52 768.88 926
Italy 347.08 566.7 1188.81
Netherlands 282.17 224.72 630.4
Norway 38.75 26.45 78.43
Poland 27.08 596.32 714.42
Portugal 67.7 230.77 359.11
Slovakia 5.13 294.61 324.84
Spain 440.61 318.44 1052.69
Switzerland 147.69 528.95 749.17
Turkey 51.72 117.25 235.99
United Kingdom 539.42 374.59 1038.02
Americas Canada 181.76 127.24 388.97
(N-S) United States 298.24 315.15 990.98
3. ASSESSMENT Data provided by the European Centre for Disease
The fact that a country counts among the worst (or least) Prevention and Control (ECDC) allows for an estimate of
affected in terms of Covid fatality rates during both the first Covid related ICU utilisation during the first and second peak
and second peak investigated here might give some indication period for some European countries, which can be interpreted
regarding its overall Covid vulnerability. However, it does not as a proxy for some of the stresses or pressures a national
allow for conclusions regarding health systems capability. For health care system may have experienced [11]. Table 3 shows
such inferences to be made, the stresses put on national health the average daily ICU occupancy rate (per 100,000) for the
care systems would have to be gauged and this data than first and second peak period, as well as the average for both
related to observed Covid deaths [10]. periods taken together for European countries for which these10 The Open Public Health Journal, 2021, Volume 14 Beck et al.
data are available. For each column, the four countries (out of shows a proxy death rate for hospitalised Covid patients which
11) with the highest ICU occupancy rates (per 100,000) are has been calculated based on Covid hospitalization data
again highlighted in red, while the four countries with the provided by the ECDC [8] and the assumption of an average
lowest rates are highlighted in green. length of Covid-related hospital stays of 5 days [12]. Data on
Covid is only available for some of the countries shown in
With the possible exception of the UK (where ICU
Table 4 plus some others. In total, we are able to present data
occupancy is relatively low for both peaks and death rates
for twelve countries. In Table 4, the four countries (out of 12)
high), high average daily Covid-related ICU occupancy rates
with the highest death are highlighted in red and the four with
during the two peak periods as well as their sum appear to be
the lowest in green.
closely related to the relative Covid fatality rates shown in the
previous Table 2. The data in Table 4 indicate significant improvements in
the proxy Covid hospitalised death rate between the first and
Table 3. Average daily Covid-related ICU occupancy rate
second peak period for seven countries (Belgium, Denmark,
(per 100,000) during the two peak periods and for both
France, Norway, Slovakia and the UK) a slight worsening for
periods together.
two (Italy and Portugal) and a more substantial worsening for
three (Austria, Czechia and Hungary). Italy’s worsening posi-
- ICU Occupancy Rates
tion is puzzling given its initial success in applying non-
- 1st Peak 2nd Peak 1st & 2nd
pharmaceutical measures during the second wave, but it has the
- April-May Nov-Dec Peak highest old-age dependency rate in the EU. The changes for
Austria 14.85 63.35 39.1 Austria, Czechia and Hungary could potentially be explained
Belgium 63.6 84.14 73.87 by the greater severity of the second peak in these countries as
Czechia 5.22 73.69 39.46 well as the geographic proximity of these countries to each
Denmark 11.31 8.54 9.92 other. Also, it must be kept in mind that data for countries with
Finland 8.97 3.79 6.38 both a relatively small population size and a relative low
France 60.24 55.03 57.63 incidence of Covid hospitalization must possibly be interpreted
Germany 23.24 47.22 35.23 with caution.
Italy 31.73 52.4 42.06
CONCLUSION
Netherlands 41.24 31.41 36.33
Portugal 8.78 25.39 17.08 Looking back at data for the first and second Covid peak
UK 29.94 19.95 24.95 which we approximated as having occurred in the two months
periods of April and May 2020 and the November and
December period of 2020, this paper suggested that for a great
Table 4. Proxy death rate of hospitalised Covid patients number of countries, Covid death have been highly con-
during the two peak periods. centrated during these periods. This highlights the impor-tance
of non-pharmaceutical interventions when Covid case numbers
- Proxy Hosp. Death Rate are on the increase. Further to this, we note that for specific
- 1st Peak 2nd Peak countries, high Covid death rates during both the first and the
April-May Nov-Dec second peak period could give an indication of overall
Austria 10.39% 12.58% vulnerability to Covid. However, as Table 4 indicates, overall
Belgium 20.91% 14.82% vulnerability to Covid is not necessarily reflected in the
Czechia 9.27% 12.42% capability of health care systems as health care providers in
Denmark 14.08% 10.64% different nations face widely different levels of pressure from
Finland 14.12% 8.73% Covid outbreaks. We suggest that some information on the
France 8.40% 7.94%
differential ability of health care systems to learn to cope with
Covid can be gained from comparing Covid deaths and Covid
Hungary 5.32% 8.72%
hospitalisations during the first and second peak period, but we
Italy 8.13% 8.64%
acknowledge that potential improvements in some countries
Norway 12.99% 9.72%
might have been adversely affected by sudden increases in
Portugal 11.13% 11.42% hospitalisations during the second peak period, the speed of
Slovakia 10.95% 7.53% learning required of public health organizations, and a lack of
UK 20.18% 12.19% matching responses and corrective actions [13].
While it should be possible to calculate a proxy death rate
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© 2021 Beck et al.
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